Coverage in myUpchar Bima Plus Insurance

If an insured person becomes ill or suffers any kind of injury and have to be hospitalized due to it, then they get to file a claim according to the insurance cover taken. According to the terms and conditions under which the policy is taken, the insured is given a claim for the following hospitalization expenses:

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• Hospitalized patient care: The company covers hospitalization for more than 24 hours under the terms and conditions under which the policy was sold. During hospitalization, you can get treatment up to your chosen sum insured. If the doctor has not asked for admission in writing and you do so of your own free will, then you will not get the claim. (Read More: Cheapest Health Insurance Plans)
• Daycare treatment: There are some diseases that do not require hospitalization for 24 hours or more. Such treatments are called day-care treatment. If there is an urgent need for such treatment, the company gives a claim of up to the sum insured as per the need for the day-care treatment, provided that the following conditions are met:
  • Treatment is on the Day-Care Treatment List as per Annexure-1 to the Policy Terms and Conditions.
  • The Life Assured should not have been admitted to a hospital or day-care center for more than 24 hours for day-care treatment.
  • The day-care treatment is being done only as per the advice of a doctor.
• Road ambulance cover: If the insured person feels the need for an ambulance and takes the services of a hospital or an ambulance service, they can file a claim for the same. After this, the insurance company looks into it and if it was really necessary to take an ambulance, then you will be given the claim according to the terms and conditions. The treating doctor can certify the need for an ambulance. Even so, the cost of road ambulance is claimed under the following rules:
  • Ambulance cover is given to the insured person from where the ambulance is needed in an emergency to the nearest hospital.
  • Ambulance cover is also given to take the patient from one hospital to another for better treatment in an emergency.

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Pre and post hospitalization coverage refers to the expenses that are incurred both before hospitalization and after discharge. If you are admitted to the hospital due to any health problem, then the expenses you incur in OPD and other forms before getting admitted for the same problem are covered under this. Additionally, the expenses related to that problem even after being discharged from the hospital are also covered by the policy. Once you make a claim for these, the insurance company investigates it thoroughly. The company checks if the expenses you are claiming have been prescribed by a doctor or not. You can claim the bills of medicines, doctor's prescriptions, tests etc. under this.

• All expenses up to 30 days prior to the date of hospitalization due to any health problem are claimed under this. However, if these expenses are incurred before the commencement of insurance coverage, they cannot be claimed.
• Expenses up to 60 days after the date of discharge from the hospital can also be claimed under this. However, you need to have a doctor's prescription and a bill for everything.
• Under pre and post hospitalization, only one doctor consultation is covered per day.
• Under this, a follow-up consultation is not covered and treatment after discharge from the rehabilitation center is also not covered in it.
• All such claims are treated as one claim if the life insured has to be admitted to the same hospital again due to the same disease within 45 days of recovery from a disease. In this case, the day of hospitalization will be reckoned as the date of the first admission. The day of the second discharge from the hospital will be treated as the day of discharge from the hospital.

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Hospitals decide the room rent and nursing expenses based on the room category you have taken. If you take a room that costs more than Rs 3,000 (1% of the sum-insured i.e. three lakhs), then other facilities will be expensive as well.

• Room rent: In such a case, the insured will also have to pay variable medical expenses (surcharge, tax etc.) out of their own pocket in the same proportion. Additionally, any amount over the 1% room rent will also have to be paid by you.
• ICU charges: In myUpchar Bima Plus, up to 2% of the sum insured per day is given as ICU expenses in case the insured needs to be admitted to the ICU. If the cost of your ICU exceeds this amount, then you will have to pay the additional charges from your savings. You will also have to pay variable medical expenses in the same proportion.
• Pre-existing disease: Your pre-existing diseases will be covered under myUpchar Bima Plus policy if you have paid three annual premiums i.e. completed the waiting period of at least 24 months. If you have increased the sum insured during this period, then you will have to wait another 24 months for the increased amount. However, you can get treatment for pre-existing diseases up to the amount for which you are insured for 24 consecutive months. You should also keep in mind that you can get treatment for only those pre-existing diseases after the specified waiting period, which you have declared in the policy form while taking it.

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